Ehrlich Matthew E, Turner Heather L, Currie Lillian J, Wintermark Max, Worrall Bradford B, Southerland Andrew M
From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
Stroke. 2016 Aug;47(8):2045-50. doi: 10.1161/STROKEAHA.116.013973. Epub 2016 Jun 30.
Noncontrasted head computed tomography (NCHCT) has long been the standard of care for acute stroke imaging. New guidelines recommending advanced vascular imaging to identify eligible patients for endovascular therapy have renewed safety concerns on the use of contrast in the emergent setting without laboratory confirmation of renal function.
We compared computed tomographic angiography (CTA) versus NCHCT alone during acute stroke evaluation with focus on renal safety and timeliness of therapy delivery. We reviewed data on all emergency department patients for whom the Acute Stroke Intervention Team was activated between December 2013 and September 2014. Primary outcomes included acute kidney injury and change in serum creatinine from presentation to 24 to 48 hours (Δ serum creatinine [Cr]). We assessed therapy delay using door-to-CT and door-to-needle times.
Of 289 patients requiring Acute Stroke Intervention Team activation, 157 received CTA and 132 NCHCT only. There was no difference between groups in mean Cr at 24 to 48 hours (1.06 CTA; 1.40 NCHCT; P=0.059), ΔCr (-0.07 CTA, -0.11 NCHCT, P=0.489), or rates of acute kidney injury (5 CTA, 7 NCHCT, P=0.422). There was no significant difference in mean intravenous tissue plasminogen activator treatment times (68.11 minutes CTA, 81.36 minutes NCHCT; P=0.577). In the 157 patients who underwent CTA, 16 (10.2%) vascular anomalies and 55 (35.0%) high-grade stenoses or occlusions were identified.
CTA acquisition during acute stroke evaluation was safe with regards to renal function and did not delay appropriate therapy delivery. Acute CTA acquisition offers additional clinical value in rapid identification of vascular abnormalities.
长期以来，非增强头部计算机断层扫描（NCHCT）一直是急性卒中成像的标准治疗方法。新的指南推荐采用先进的血管成像来确定适合进行血管内治疗的患者，这再次引发了人们对在未进行实验室肾功能确认的紧急情况下使用造影剂安全性的担忧。
我们在急性卒中评估期间比较了计算机断层血管造影（CTA）与单独使用NCHCT的情况，重点关注肾脏安全性和治疗的及时性。我们回顾了2013年12月至2014年9月期间所有激活急性卒中干预团队的急诊科患者的数据。主要结局包括急性肾损伤以及从就诊到24至48小时血清肌酐的变化（血清肌酐变化量[Cr]）。我们使用从门到CT和从门到穿刺时间评估治疗延迟情况。
在289名需要激活急性卒中干预团队的患者中，157名接受了CTA检查，132名仅接受了NCHCT检查。两组在24至48小时的平均肌酐水平（CTA为1.06；NCHCT为1.40；P = 0.059）、肌酐变化量（CTA为 - 0.07，NCHCT为 - 0.11，P = 0.489）或急性肾损伤发生率（CTA组5例，NCHCT组7例，P = 0.422）方面无差异。平均静脉注射组织纤溶酶原激活剂治疗时间也无显著差异（CTA组为68.11分钟，NCHCT组为81.36分钟；P = 0.577）。在接受CTA检查的157名患者中，发现了16例（10.2%）血管异常和55例（35.0%）高度狭窄或闭塞。
在急性卒中评估期间进行CTA检查在肾功能方面是安全的，并且不会延迟适当治疗的实施。急性CTA检查在快速识别血管异常方面具有额外的临床价值。
